tbuckley/cabot-search huggingface dataset:
Abstract 14869: In-Hospital Outcomes and Predictors of Patients With Infective Endocarditis Undergoing Transcatheter Aortic Valve Replacement
Authors: Bertrand Ebner, Sukhpreet Kaur, Karla Inestroza, Miguel Martillo, Ian Ergui, michael Albosta, Carlos Vergara-Sanchez, Rafael J Hernandez, Michael Dangl, Jelani Grant, LOUIS VINCENT, Jennifer Maning, Neal Olarte, Rosario Colombo
Journal: Circulation (2022)

Background: Although there is no clear indication on transcatheter aortic valve replacement (TAVR) in patients with infective endocarditis (IE), in some instances, TAVR remains the only possible option in some clinical scenarios. Methods: The National Inpatient Sample Database was queried from 2011-2019 for relevant ICD-9 and -10 diagnostic and procedural codes. Baseline characteristics and in-hospital outcomes of patients with a diagnosis of IE undergoing TAVR were queried. The association of baseline comorbidities with in-hospital mortality was determined using a binary logistic regression model to obtain adjusted odds ratios (aOR). Results: A total of 750 patients were identified with IE who underwent TAVR (0.3% of patients undergoing TAVR). In this cohort, 60% were male and 85% were white. Mean age was 73 ± 14 years old. At baseline, patients with IE had a prevalence of 80% of heart failure, 74% of hypertension (HTN), 58% of coronary artery disease (CAD), 49% of hyperlipidemia (HLD), 41% of chronic kidney disease (CKD), 39% of atrial fibrillation (AF), 29% of tobacco use, 27% of pulmonary hypertension, 23% of diabetes, 17% of peripheral vascular disease and 15% of history of stroke, amongst the most common ones. In-hospital death was 7.3% with a median length of stay of 8 days [IQ 2-19]. This population had an 85% rate of sepsis, 34% of acute kidney injury with 9% need of renal replacement therapy. Major bleeding was present in 17% with need of blood product transfusion in 17% of the cases. Other complications found were cardiogenic shock (13%), complete heart block (11%), vascular complications (7%), pericardial effusion (7%) with 3% of pericardiocentesis, 4% intraoperative cardiac complications and 5% of cardiac arrest. Mortality was mainly associated with HLD (aOR 11.073 [4.363-28.101]), HTN (aOR 3.863 [2.209-6.755]), HF (aOR 2.491 [1.392-4.456]) and CAD (aOR 2.597 [1.469-4.592], p&lt;0.05 for all). Conclusion: We found a higher mortality post-TAVR in patient with IE than the general population undergoing TAVR (~4%). Controlling baseline comorbidities such as HLD, HTN and HF might be an important treatment part to decrease the risk of in-hospital mortality post-TAVR in patient with IE. Further prospective studies are needed to elucidate these findings.
Abstract 13997: What is the Role of Pulmonary Artery Catheterization in Patients With Acute Myocardial Infarction Complicated With Cardiogenic Shock?
Authors: Mohit Pahuja, Aakash Tuli, Brian C Case, Akhil Kallur, ITSIK Ben-Dor, Adam Johnson, Hayder Hashim, Abhinav Saxena, Cheng Zhang, Corey Shea, hank rappaport, Lowell F Satler, Farooq Sheikh, Nelson L Bernardo, Ron Waksman
Journal: Circulation (2022)

Background: Acute myocardial infarction (AMI) remains one of the most common cause for cardiogenic shock (CS). Emergent revascularization with and without mechanical support demonstrated the benefit in patients with AMI-CS, but data on the utility of pulmonary artery catheter (PAC) in patients with AMI-CS is lacking. Methods: We performed a retrospective study from a large healthcare system (11 hospitals) from October 1 st 2014 to October 2021. We divided the patients with AMI-CS, into two groups those who received PAC and those who did not. Propensity matched analysis was performed for baseline characteristics, comorbidities, and laboratory values to account for the underlying cofounders. The in-hospital outcome was recorded for both groups Results The total cohort included 2585 patients (STEMI: 797; NSTEMI: 1788). Of these 517 patients underwent PAC placement: 19.7 % of the patients in the STEMI group, and 20.4% of patients in the NSTEMI group. Mean age was similar among the PAC and the non-PAC groups (68.87 years vs 67.12 years respectively. Patients who underwent PAC had more diabetes (59.4% vs 53.1%, p=0.011), chronic kidney disease (50.9% vs45.2%, p=0.020), and coronary artery disease (77.8% vs 71.9%, p = 0.007). Overall, in-hospital mortality was lower in patients who underwent PAC and higher in patients who did not receive PAC (25.9% vs 35.9%, p&lt;0.001) and these results remained significant after propensity matching as shown in Figure 1. Similar results were seen across all SCAI stages with improved mortality in PAC group. Overall mechanical circulatory device utilization was higher in the PAC group. Conclusion Our study shows that the use of PAC patients with AMI-CS was associated with improved mortality. If proven in randomized clinical trials PAC should be routinely used for all patients presenting with AMI-CS.
Abstract 140: Sex-specific Behavioral And Neurological Outcomes After Experimental Asphyxial Cardiac Arrest
Authors: Ashley L Russell, Emma Dimeo, Kelsey E Kline, Ian Gober, Jason P Stezoski, Tomas Drabek, Patrick M Kochanek, Amy K Wagner
Journal: Circulation (2022)

Background: Although survival rates after asphyxial cardiac arrest (ACA) have improved, survivors face neurological disability from hypoxic ischemic brain injury. Hippocampal CA1 and striatum, which affect cognitive function, are vulnerable. Targeted temperature management (TTM) is the only recommended intervention to improve outcome, yet preclinical studies are lacking on sex-linked behavioral and neurological outcomes after TTM. Hypothesis: TTM produces sex-specific differences in CA1 and striatal associated behavioral and neurological outcomes after ACA. Methods: Adult male and female Sprague-Dawley rats underwent sham or 5-min no-flow ACA. Temperature was controlled for 18h post-ACA at either 37-38°C (normothermia; n=9 males; 14 females) or 36-37°C (TTM; n=9 males; 8 females). Rats underwent neurological deficit scoring (NDS) and behavior testing over 14d. Behavior measures included: coordination, balance, sensorimotor function [acoustic startle response (ASR)] and myoclonus. Neuropathology was examined (cell death [CA1] and microglial infiltration [CA1 and striatum]) at 14d. Results: After ACA, females were less likely to achieve ROSC vs males (76% vs 92%). Females had a longer time to ROSC (p&lt;0.05); but insult severity was similar between sexes based on post-ROSC blood gases. Females had lower NDS vs males at 1-3d post-ACA (p&lt;0.05). ACA females had better coordination, balance, lower ASR, and fewer myoclonic events vs males (p&lt;0.05). ACA females and males had similar amounts of CA1 dead (eosinophilic) and degenerated (fluorojade-B+) neurons and microglia (Iba1). ACA did not impact the number of striatal microglia in either sex vs sham; however more striatal microglia were “activated” than “resting” after ACA. TTM improved survival and NDS in males and females (p&lt;0.05). TTM improved coordination and balance only in males (p&lt;0.05). TTM did not reduce increases in ASR or CA1 death/degeneration. Ongoing work is exploring the effect of TTM on microglial number/activation. Conclusions: Females post-ACA have a lower ROSC but better behavioral outcomes vs males. TTM selectively improved behavioral recovery in males but did not impact CA1 injury. We provide preclinical insight into sex-specific ACA responses, using TTM as a therapy.
Abstract 14199: Defining Phenotypic Representativeness of the TOPCAT Trial to a Real-World Electronic Health Record Using Multidimensional Phenomaps
Authors: Phyllis Thangaraj, Evangelos Oikonomou, Rahul Jayaram, Arash Aghajani Nargesi, Marc Suchard, Rohan Khera
Journal: Circulation (2022)

Background: The TOPCAT trial did not find an overall benefit of spironolactone in the management of HFpEF. However, subsequent investigations have found heterogeneous treatment effects across patients, questioning the extent TOPCAT is representative of the real world. Previous analyses addressing this question have been limited by focusing on single phenotypic axes that do not capture the entirety of the patient phenotypes. Methods: We constructed a multidimensional phenomap of TOPCAT on 76 pre-randomization characteristics spanning demographics, diagnoses, procedures, medications, labs, vitals, conditions, and imaging-derived measures. We then compared this map to patients with HFpEF in the EHR of the Yale-New Haven Hospital. The EHR cohort was based on echocardiography and selected if they had a HF hospitalization during 2015-2019. All corresponding 76 features were extracted for the Yale EHR population by a team of clinicians and data scientists. To accomplish this, we computed a pairwise Gower dissimilarity metric across the 76 pre-randomization characteristics. Results: Compared with TOPCAT participants (n=3445), Yale EHR (n=2394) patients were older (69 vs 78 years), more frequently women (52% vs 57%), and Black (9% vs 17%). In univariate analyses, there was similar use of anti-hypertensive therapy. Mutlivariately, however, there was minimal overlap of the clinical population in TOPCAT compared with the Yale EHR, with a median patient-level dissimilarity distance of 41% (IQR 35% - 43%) ( Fig A ), with qualitative separation in the clinical populations in the trial and EHR ( Fig B ). Conclusions: In assessments across 76 phenotypic features, there was minimal similarity in patients in TOPCAT and real-world patients drawn from EHR, suggesting challenges with generalizability of the findings. Phenomapping-based strategies can enhance quantitative and qualitative assessment of trial representativeness to real-world populations.
Abstract 13989: Glutaredoxin-1: A Redox Regulator of Metalloproteases in Vascular Endothelial Cells
Authors: Jingyan Han, Hanxiao Liu, Yuko Tsukahara, xuping wan, Sandra Sulser Ponce De Leon, Enkhjargal Budbazar, Francesca Seta
Journal: Circulation (2022)

Background: Endothelial dysfunction is a common mediator of aneurysmal remodeling regardless of etiology and the vascular bed that occur (e.g., genetic mutations, hypertension, aging, smoking, abdominal or thoracic artery or aortic root), but the underlying mechanisms remain unknown. This work aims to test the hypothesis that perturbing thiol redox signaling in endothelial cells triggers aberrant activation of matrix metalloproteinase-2 and -9, thereby precipitating aneurysmal remodeling. Methods and Results: In human aortic aneurysm (AA) samples from individuals with Marfan syndrome, levels of MMP-2/-9 were increased drastically that coincided with elevated oxidative stress markers: tyrosine nitrated proteins and lipid peroxidation product 4-hydroxynonenal . In mouse model of AA: fibrillin-1 mutant( Fbn1 mgR/mgR ) mice, reversible oxidation of cysteine residues—S-glutathionylation (PrS-SG) that mediate thiol redox signaling by modulating target proteins’ functions—were markedly elevated as an early redox event. Endothelial specific deletion of glutaredoxin-1(Grx1), a specific de-glutathionylation enzyme was found to massively increase gelatinase activity of MMP-2/-9 in whole aortas, and worsen vessel wall integrity. Using primary human aortic ECs, we showed that Grx1 can directly prevent pro-MMP-2/-9 from glutathionylation of their cysteine switch and consequent activation. Furthermore, the medium collected from HAECs that lack functional Grx1 stimulated MMP-2 activity in smooth muscle cells, thus setting up an amplifying mechanism of MMP activation. Conclusions: this study is the first to provide experiment evidence for a pathogenic role of dysregulated thiol redox signaling in vascular endothelial cells in aneurysmal remodeling.
Abstract 14169: Quantitative Echocardiographic Assessment and Optimal Criteria for Early Intervention in Asymptomatic Tricuspid Regurgitation
Authors: Emmanuel O Akintoye, Tom Kai Ming K Wang, Michael Nakhla, Adel Hajj Ali, Agostina Fava, Kevser Akyuz, Zoran B Popovic, Gosta B Pettersson, A M Gillinov, Bo Xu, Brian P Griffin, Milind Y Desai
Journal: Circulation (2022)

Introduction: Tricuspid regurgitation (TR) is associated with poor outcome and high operative mortality due to late presentation; yet the optimal timing for TR intervention remains controversial, especially in asymptomatic patients. We evaluated the prognostic value of echocardiographic parameters to inform early intervention in asymptomatic TR Methods: We identified cohort of consecutive asymptomatic patients with moderate to severe (3+) or severe (4+) TR who underwent echocardiography at Cleveland Clinic during 2004-2018. Quantitative TR as well as right heart size and function parameters were determined and their prognostic utility and optimal thresholds for all-cause mortality were assessed in time-to-event analyses Results: In 325 asymptomatic TR patients (mean age 68 years; 79% female), there were 132 deaths (41%) over a median follow up of 7 years (IQR 4-11). Among the twenty echocardiographic parameters evaluated, right ventricle free wall strain (RVFWS) and tricuspid regurgitant volume (RVol) were the strongest predictors of mortality in the cohort. The optimal discriminatory thresholds for these parameters were RVFWS &lt;-19% and RVol &gt;45 mL ( Fig 1 ). The 5-year survival rates (95% CI) by number of risk factors (RF) were 93% (86-96%), 65% (55-74%), and 38% (26-49%) for no RF, one RF, and both RF, respectively. Compared to symptomatic TR, mortality was lower for asymptomatic TR with no RF [HR (95% CI) =0.10 (0.04-0.29)] or one RF [0.29 (0.14-0.58)], but similar for asymptomatic TR with both RF [1.11 (0.56-2.19)] ( Fig 2 ) Conclusion: RVFWS and RVol are key prognostic markers that can be serially monitored to inform optimal timing of intervention for severe asymptomatic TR
Abstract 12808: Genetic Heart Disease and Gender-Affirming Hormone Therapy in Transgender Individuals: Potential Pro-Arrhythmic Considerations
Authors: Alexa M Pinsky, S Yukiko Asaki, Sahej Bains, Johan M Bos, Susan P Etheridge, Michael J Ackerman
Journal: Circulation (2022)

Background: Sex hormones influence the arrhythmogenic risk for various genetic heart diseases (GHDs) including long QT syndrome (LQTS), Brugada syndrome (BrS), catecholaminergic polymorphic ventricular tachycardia (CPVT), and idiopathic ventricular fibrillation (IVF). Although exogenous hormones are used frequently in transgender medicine for gender-affirming hormone therapy (GAHT), the effect of such treatments on sudden cardiac death (SCD) risk in transgender patients with a GHD is unknown. Objective: To describe the prevalence and spectrum of transgender patients with GHD and to evaluate the impact of GAHT on the treatment and outcomes of their underlying GHD. Methods: We performed a retrospective review of all patients seen and evaluated in Mayo Clinic’s Windland Smith Rice Genetic Heart Rhythm Clinic from January 1999-2022 to identify transgender patients. Clinical notes were reviewed for sex, gender identity, GAHT, and details of their GHD, therapy, and outcomes. Results: Among 1990 patients with a GHD, we found 7 patients (0.35%) who self-identify as a gender different from their chromosomal sex (transgender). Specifically, there were 4 patients who identified as transgender women (XY males at birth) and 3 as transgender men (XX females at birth). Five of seven patients (71%) have used forms of GAHT, with 2 patients on estradiol and 3 patients on testosterone. GHDs identified include LQT1 (2 transgender women), LQT3 (1 transgender man), LQT3/BrS overlap syndrome (1 transgender woman), genotype negative LQTS (1 transgender man), CPVT (1 transgender woman), and IVF (1 transgender man). Guideline-directed GHD therapy was optimized, not altered nor escalated, for all patients and no patients were advised against initiating GAHT due to perceived interactions. One of seven patients (transgender man with IVF) experienced a breakthrough cardiac event (BCE) while on GAHT, while the other 6 patients have had no BCEs. Conclusion: Although less than 0.5% of patients seen over 20+ years self-identified as transgender, their holistic care must include a careful discussion of the possible cardiac risks associated with GAHT. Additional studies are needed to determine the potential pro-arrhythmic risk of GAHT.
Abstract 13512: Patiromer to Manage Hyperkalemia in Patients Receiving Optimized Renin-Angiotensin-Aldosterone System Inhibitors for Heart Failure (DIAMOND): Prespecified Analysis of Patients With Hyperkalemia or Previous Hyperkalemia
Authors: Andrew J Coats
Journal: Circulation (2022)

Introduction: Renin-angiotensin-aldosterone system inhibitors (RAASis) are central to the treatment of heart failure with reduced ejection fraction (HFrEF); hyperkalemia (HK) or fear of HK often leads to suboptimal RAASi use. In the DIAMOND trial, 85% of patients with HFrEF and HK (serum potassium [sK + ] ≥5.0 mEq/L) or previous HK, which had led to RAASi discontinuation, achieved optimal RAASi and mineralocorticoid receptor antagonist (MRA) doses with open label run-in patiromer treatment. The benefit of using patiromer in patients with current HK vs a history of HK is unknown. Methods: Patients with HFrEF and either present HK or previous HK entered a single-blinded run-in phase ≤12 weeks to optimize RAASi while receiving patiromer; then were randomized (1:1) double-blind to continue with patiromer, or patiromer withdrawal (placebo). The primary endpoint was the mean change in sK + from baseline (BL) to the end of study. Secondary endpoints were: sK + &gt;5.5 mEq/L, durable enablement of MRA at target dose, adverse events (AEs) of HK, HK-related hard outcomes, and a win ratio of novel RAASi use score. This prespecified analysis was conducted in patients with HK or with previous HK. Results: Of 1195 patients entering the run-in phase, 878 were randomized, of whom 354 (40%) had HK on study entry and 524 (60%) had normokalemia at BL. Of patients with HK (83.9%) and patients with previous HK (85.3%) achieved patiromer-facilitated RAASi optimization during the run-in. Patiromer consistently controlled sK + in patients both groups. A greater effect of patiromer on maintaining MRA at target dose, was seen in patients with HK versus those with previous HK. Conclusion: In patients with HFrEF, patiromer can effectively control sK + and facilitate the optimization of MRA use, this may be of most benefit to patients with HK.
Abstract 13656: Symptoms and Outcomes Are Not Related to Regurgitant Severity in Guideline Directed Mitral Valve Surgery
Authors: Seth Uretsky, Robert W Biederman, Yuchi Han, Ron M Jacob, Andrew D Choi, Edward T Martin, Michael Langer, Ibrahim Sultan, Joao L Cavalcante, Dipan J Shah, Matthew Tong, Steven Wolff, Marco Guglielmo, Gianluca Pontone
Journal: Circulation (2022)

Introduction: The purpose of this study was to assess symptoms in patients undergoing class I/IIa ACC/AHA guideline directed lone mitral valve surgery. Hypothesis: Symptoms in patients undergoing guideline directed mitral valve surgery and are not associated with the severity of mitral regurgitation (MR). Methods: In this prospective multicenter study, 93 patients with a Class I/IIa indication for isolated mitral valve surgery were evaluated. Each patient had a cardiovascular magnetic resonance (CMR) exam prior to surgery and 3 to 5 months following surgery. The presence or absence of symptoms was determined by the treating physician. Symptoms were quantified using the Kansas City Cardiomyopathy Questionaire (KCCQ). Results: There were 55 (59%) patients who were symptomatic preoperatively. Based on CMR regurgitant volume, 30%, 39%, and 31% had mild, moderate, or severe MR, respectively. Among those with mild, moderate, and severe MR, the percentage of patients who were symptomatic at baseline did not differ significantly and the severity of symptoms as quantified by the KCCQ did not differ significantly (Figure1A). Post-surgical improvement in the percentage of patients with symptoms and the KCCQ score did not differ based on baseline MR severity (Figure1B). Patients who were symptomatic before surgery reported the greatest improvement in KCCQ symptom score following surgery compared to those who were asymptomatic at baseline (17 ± 25 vs. -0.4 ± 17, p&lt;0.001). Conclusions: In a multi-center study of patients undergoing ACC/AHA class I/IIa indication for surgery for MR there was no of correlation between MR severity and symptoms. These findings question the assumptions that severity of MR is associated with worse symptoms prior to surgery and those with severe MR benefit the most from mitral valve surgery. The lack of correlation between MR severity, symptoms, and outcomes is concerning and it suggests symptoms may be often misattributed to MR.
Abstract 13438: Resource Utilization and Outcome Trends of Intravascular Physiologic Testing During Percutaneous Coronary Intervention - United States National Inpatient Database Analysis 2014 Through 2019
Authors: Muhammad Usman Almani, Muhammad Qudrat Ullah, Muhammad Usman, Carlos Matute-Martinez, Muhammad Yousuf, Aviral Vij
Journal: Circulation (2022)

Introduction: Physiologic assessment of intermediate coronary stenosis has shown superiority in guiding decision making when compared to angiographic assessment alone. Many recent trials have shown improved outcomes using resting or hyperemic indices for severity assessment. In this study, we aimed to analyze the trends of intravascular physiologic testing during percutaneous coronary intervention (PCI), adjusted in-hospital mortality, adjusted in-hospital stay and adjusted hospital cost. Methods: Data were extracted from the National Inpatient Sample (NIS) 2014 through 2019 Database. The NIS was searched for PCI with and without intravascular physiologic testing in adult patients (age ≥18) using ICD 9 and 10 codes. Outcomes of interest were utilization rates of intravascular physiologic testing during PCI, trend of adjusted in-hospital mortality, adjusted mean LOS and adjusted mean hospital cost. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used for analysis. Results: Of 2,871,865 PCIs in 2014 through 2019, 118,795 (4.1%) were coupled with intravascular physiologic testing. The use of intravascular physiologic testing during PCI steadily increased from 2.8% in 2014 to 5.0% in 2019 (trend p &lt;0.001). The adjusted in-hospital mortality for PCI with physiologic testing did not show any significant statistical linear trend through the years (0.8% in 2014 vs. 0.9% in 2019, trend p=0.123). The mean adjusted LOS remained the same (3 days, trend p=0.530), whereas, mean adjusted hospital cost showed a linear trend of higher hospital cost (24033$ in 2014 vs. 25434$ in 2019, trend p=0.014). Conclusions: There is a rise in use of coronary intravascular physiologic testing during PCI. No statistically significant linear trend was observed in terms of in-hospital mortality or LOS for PCI with intravascular physiologic testing, however, over the years the mean hospital cost is on the rise.